title: Islet autotransplantation after extended pancreatectomy for focal benign disease of the pancreas.
abstract: BACKGROUND
  Extended pancreatectomy is associated with the risk of surgical diabetes. Islet autotransplantation is successful in the prevention of diabetes after pancreas resection for chronic pancreatitis (CP), with insulin independence rates of 50% at 1 year. The aim of the present study is to demonstrate the safety and efficiency of islet autotransplantation after extended left pancreatectomy for benign disease.
  
  
  METHODS
  Between 1992 and 2009, 25 patients underwent extended pancreatectomy and islet autotransplantation for benign disease. Of these, 15 patients were operated for focal lesions located at the neck of the pancreas (14 benign tumors and 1 traumatic pancreatic section), the remainder being CP cases. After unequivocal diagnosis of benignity, the rest of the pancreas was processed and infused into the portal vein. Metabolic results were analyzed and isolation results were compared with those obtained from patients with CP or donors with brain death (DBD).
  
  
  RESULTS
  There was no mortality and a low morbidity (Streptococcus mitis bacteremia in 1 patient), no portal thrombosis or pancreatic fistula occurred. Median follow-up was 90 months. Actuarial patient survival was 100% at 10 years. Actuarial insulin independence was 94% at 10 years. All patients had positive basal and stimulated C-peptide levels and normal HbA1c. Mean islet yields were 5455 IEQ/gram vs. 1457 in CP (P=0.001) and 3738 in DBD (P=0.003).
  
  
  CONCLUSIONS
  Islet autotransplantation after extensive pancreatic resection for benign disease is a safe and successful procedure. Islet yields after isolation, which are equivalent to the live donor situation, are significantly better than those from DBD donors.
authors.affiliation: Division of Visceral and Transplantation Surgery, Geneva University Hospitals and University of Geneva School of Medicine, Geneva, Switzerland.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Ris
authors.forename: Nadja
authors.initials: N
authors.lastname: Niclauss
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Sandrine
authors.initials: S
authors.lastname: Demuylder-Mischler
authors.forename: Yannick
authors.initials: Y
authors.lastname: Muller
authors.forename: Raphael
authors.initials: R
authors.lastname: Meier
authors.forename: Muriel
authors.initials: M
authors.lastname: Genevay
authors.forename: Domenico
authors.initials: D
authors.lastname: Bosco
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000601:surgery; D013557:Switzerland; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin